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Friday, October 20, 2017

hypertensionAfter more than 10 years since the 4th Report, an updated comprehensive blood pressure guideline for pediatric specialists has recently been published by the American Academy of Pediatrics. The Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents, the unofficial 5th Report, provides 30 graded Key Action Statements that include the level of evidence and strength of the recommendation. With a focus on improving the recognition and diagnosis of hypertension in children, there are several features of the AAP clinical practice guideline that deserve highlighting. The AAP subcommittee developed a simplified table for screening blood pressure values based on the 90th percentile blood pressure at the 5th height percentile for each gender and age. The simple table may be used by the health care provider doing the initial blood pressure measurement to determine if the treating physician needs to review and/or repeat the measurement. In addition, the classification of hypertension in adolescents (≥ 13 years of age) has been simplified to threshold values that are consistent with the upcoming ACC/ AHA adult blood pressure guidelines. In children (<13 years), where blood pressure percentiles continue to define hypertension, the normative data has been improved with removal of data from children who were overweight or obese to be more representative of a healthy population. Investigation of confirmed hypertension has been clarified and simplified given the high rates of primary hypertension in the US population. This comprehensive guideline was developed by the AAP in partnership with several associations including the Canadian Association of Paediatric Nephrologists.   The guidelines are available through Open Access following the link below:

  1. Flynn JT, Kaelber DC, Baker-Smith CM, Blowey D, Carroll AE, Daniels SR, de Ferranti SD, Dionne JM, Flinn SK, Falkner B, Gidding SS, Goodwin C , Leu MG, Powers ME, Rea C, Samuels J, Simasek M, Thaker VV, Urbina EM, for the Subcommittee on Screening and Management of High Blood Pressure in Children. Clinical Practice Guideline for Screening and Management of High Blood Pressure in Children and Adolescents. Pediatrics 2017;140(3) e2017190

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